| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1220 |
Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
186 |
160 |
$1.41M |
| K0108 |
Wheelchair component or accessory, not otherwise specified |
877 |
629 |
$1.02M |
| E1399 |
Durable medical equipment, miscellaneous |
289 |
164 |
$561K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
8,511 |
7,853 |
$397K |
| K0005 |
Ultralightweight wheelchair |
170 |
154 |
$277K |
| E0601 |
Continuous positive airway pressure (cpap) device |
3,604 |
3,262 |
$103K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
787 |
713 |
$71K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
2,242 |
2,078 |
$70K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
755 |
540 |
$60K |
| E0431 |
Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing |
3,672 |
3,315 |
$42K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
3,934 |
1,979 |
$38K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
777 |
327 |
$31K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
85 |
75 |
$31K |
| E0570 |
Nebulizer, with compressor |
2,199 |
2,020 |
$28K |
| K0040 |
Adjustable angle footplate, each |
308 |
233 |
$26K |
| E2201 |
Manual wheelchair accessory, nonstandard seat frame, width greater than or equal to 20 inches and less than 24 inches |
1,191 |
1,046 |
$25K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
145 |
112 |
$25K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
26 |
26 |
$23K |
| E0630 |
Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s) |
718 |
654 |
$21K |
| K0001 |
Standard wheelchair |
2,060 |
1,889 |
$19K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
250 |
210 |
$15K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
579 |
519 |
$12K |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
341 |
256 |
$11K |
| K0004 |
High strength, lightweight wheelchair |
489 |
407 |
$9K |
| E0466 |
Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) |
28 |
25 |
$8K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
77 |
56 |
$7K |
| E1392 |
Portable oxygen concentrator, rental |
733 |
653 |
$7K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
34 |
34 |
$7K |
| A7030 |
Full face mask used with positive airway pressure device, each |
141 |
126 |
$7K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
276 |
209 |
$5K |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
234 |
158 |
$5K |
| E2211 |
Manual wheelchair accessory, pneumatic propulsion tire, any size, each |
125 |
61 |
$4K |
| A7037 |
Tubing used with positive airway pressure device |
463 |
397 |
$4K |
| E0562 |
Humidifier, heated, used with positive airway pressure device |
192 |
188 |
$4K |
| A7035 |
Headgear used with positive airway pressure device |
399 |
344 |
$3K |
| K0816 |
Power wheelchair, group 1 standard, captains chair, patient weight capacity up to and including 300 pounds |
65 |
64 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
34 |
13 |
$2K |
| E2213 |
Manual wheelchair accessory, insert for pneumatic propulsion tire (removable), any type, any size, each |
37 |
30 |
$1K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
77 |
58 |
$1K |
| A7038 |
Filter, disposable, used with positive airway pressure device |
343 |
256 |
$975.19 |
| E0470 |
Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) |
13 |
12 |
$577.08 |
| E0163 |
Commode chair, mobile or stationary, with fixed arms |
16 |
13 |
$239.30 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
62 |
54 |
$173.82 |
| A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
27 |
25 |
$155.89 |
| A7003 |
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable |
83 |
77 |
$88.78 |
| A7039 |
Filter, non disposable, used with positive airway pressure device |
13 |
12 |
$51.12 |
| E0156 |
Seat attachment, walker |
22 |
12 |
$41.39 |